Evangelical Organizations & Tuberculosis in Japan

A review of The Exponent of Breath: The Role of Foreign Evangelical Organizations in Combating Japan’s Tuberculosis Epidemic of the Early Twentieth Century, by Elisheva Perelman.

In this dissertation Elisheva Perelman charts the establishment of American evangelical organizations in Japan, for whom the turn of the century tuberculosis epidemic proved a fortuitous opportunity to gain a foothold in the country. Although Japan’s modernization led to a swelling in the ranks of skilled physicians and research scientists, the urbanized labor with which it was associated also provided fertile conditions for the spread of contagions; none more so than tuberculosis which, by the beginning of the Taishō period (1912-1926) was ravaging Japan’s military and civilian labor force. Citing figures from the Infectious Disease Institute, Perelman notes that in 1913 tuberculosis accounted for approximately 40% percent of deaths in the army, and for an equal number of soldiers discharged for disability (p. 43). Ultimately, the financial costs of the disease were almost as high as military spending itself.

Of these military figures we can be relatively certain. However, reliable figures of mortality in the civilian population are harder to come by, due in part to the lack of coordination in compiling such statistics but more so because of under-reporting owing to the stigma of the disease. Perelman points out that the civilians most affected were the urban poor, prominent among whom were female textile workers. Although celebrated as “flowers of the people” (p. 35), these women were in fact a cheap and easily replenishable resource. And as textiles were the backbone of Japan’s modernization, the government was loath to carry out any intervention that might jeopardize its all-important foreign exchange earner. Even if the government had desired to provide care they would have been stymied. Japan’s public health system was already overwhelmed and private hospitals, regarded by many as opportunistic profiteers, were hardly an alternative. Perelman shows how the government’s delay in providing palliative care for the majority of tuberculosis sufferers created an inviting gap for American protestant missionary groups. It afforded them an opportunity to engage in what Perelman terms “moral entrepreneurism”, a transaction wherein currency was denominated in the souls of the afflicted.

Fertile territory though Japan may have initially seemed to missionaries, it proved relatively barren when it came to providing converts. Paradoxically, it was this lack of success that smoothed the acceptance of evangelists by the political class on whom they relied to continue their activity. The force of this contradiction drives Perelman’s analysis. She is guided in this engaging study by the question “cui bono” — to whose benefit? The core of the dissertation contrast two organizations — the Young Men’s Christian Association (YMCA) and the Salvation Army — and two individuals — Dr Rudolf Bolling Teusler (1876-1934) and William Merrell Vories (1880-1964) — all of whom were involved in evangelically-motivated medical care. Through painstaking analysis of vast archival sources, Perelman teases out the voices of the key actors, deftly allowing their idiosyncrasies, prejudices, motivations to come to the fore.

The study starts with an introduction of the key agents in this enterprise. Aptly, Perelman starts with tuberculosis, granting it its agency. After all, it was this disease, through its invasion of benign lesions in the lung, that compromised the physical health of patients thereby providing medical missionaries with a worthy raison d’être. The decay attributed to the disease was not only physical. Many felt that failure to overcome it pointed to moral deficiency, and here too was an area that missionaries felt they could certainly address. Also introduced are politicians. Ōkuma Shigenobu 大隈重信 (1838-1922), former prime minister and founder of Waseda University, gains much attention here, mainly because his attitude toward Christianity exemplified the broader mood among the political class. Having being involved in the arrest of Christians early in the Meiji period, Ōkuma later came to appreciate the utility of foreign missionaries. The lowly textile worker, who provided the motor for the Japan’s modernization while bearing the brunt of its success, comes last.

Chapter 2 explores the missionaries’ attitudes toward Japan and Japanese attitudes toward Christianity. This section charts the attitudinal shift during the Meiji period (1868-1912). Initially, the religion proved attractive to disenfranchised samurai who saw it as means of asserting their individuality. However, by the time missionary organizations were active in Japan, most of them had already renounced their faith. Nevertheless, Japan remained attractive in the missionary imagination. Evangelists, often with encouragement of Japanese Christians, regarded Japan as ripe for their activity, seeing the populace receptive and polite. Aware that offense could jeopardize their activities, missionaries often went to great lengths to ingratiate themselves with their hosts, voicing support, for example, for their wars. For their part, Japanese were largely receptive to missionaries’ medical assistance. Some politicians and businessmen even offered financial support.

Chapters 3 and 4 contrast the activities and accomplishments of the YMCA and the Salvation Army. The YMCA arrived in Japan in the 1880s but it was the Russo-Japanese war (1904-5) that provided them a platform to demonstrate their utility. They were given access to theaters of war to provide psychological support to ill soldiers during their lengthy convalescence. By focusing their efforts on such acceptable subjects and avoiding more politically sensitive groups such as the urban poor and industrial workers, they found acceptance among the political and middle classes. However, consequently, once the war was over they lost relevance, something they were only able to regain decades later through their emergency relief after the Great Kanto earthquake of 1923. The Salvation Army, on the other hand, was more assertive. They were noted for their “native policy” whereby they adopted (or aped, rather) Japanese forms of dress, diet and lifestyle. Their attempts attracted ridicule, but also audiences. They were less reticent than the YMCA in working with the urban disenfranchised and so set up sanatoria to provide care to ill workers. In doing so, they were arguably more successful in reaching those who would have otherwise fallen through the cracks in the system.

The concluding chapter looks at two individuals. Rudolf Bolling Teusler was a physician who took the helm at St. Luke’s Hospital in Tokyo. Although established for the care of foreigners, the hospital became significant for the care of ill Japanese. Although Teusler was initially slow to employ Japanese physicians (and then to pay them equally to foreign doctors), he made an important contribution in creating a nursing school that trained corps of carers for tuberculosis sufferers. William Merrell Vories, also known as Hitotsuyanagi Mereru 一柳米来留, is also notable for having created an important center for treatment. His Omi Sanatorium was feted as one of Japan’s best despite its location in Japan’s remote interior, and for this he earned an audience with the Emperor. The sanatorium was, however, only his most successful missionary endeavor in Japan. Having initially traveled to rural Japan as a teacher under the condition that he kept Christianity out of the classroom, he fell afoul of local clergy who (according to him) resented his success in spreading his faith. He then made a foray into architecture designing buildings in Japan for evangelical use. It was through happenstance — through the sales of a popular “healing cream” — that he was granted the resources to achieve his most successful missionary activity in Japan.

The key accomplishment of this richly researched study is its interweaving of strands that are often treated separately — protestant proselytism, gender, industrialization and disease. By demonstrating how workers, and in particular female textile workers, lost their agency through becoming collateral in a transaction between politicians and proselytizers, Elisheva Perelman buttresses analyses by scholars, such as Hosoi Wakizō, E. Patricia Tsurumi, Janet Hunter and Mikiso Hane, who have highlighted the sacrificial existence of women workers in Japan at the turn of the twentieth century.

The National Council of YMCAs of Japan
The Salvation Army Research Room Archives, Tokyo
The Salvation Army National Archives and Research Centre, Alexandria VA
The Archives of the Episcopal Church, Austin TX
National Archives of Japan
Online Archive of California and others